Premature ovarian insufficiency: current progress and future prospectives

Premature Ovarian Insufficiency (POI) is defined as the occurrence of hypergonadotrophic hypoestrogenic amenorrhea in women under the age of 40 years. POI represents the end of a gradual process of loss of primordial follicles that evolves silently to premature menopause. POI can be primary or induced by radiation, chemotherapy or surgery. The majority of spontaneous POI is idiopathic. No guidelines have been established regarding management of infertility in POI patients and currently no interventions have shown to remarkably increase the prospective of spontaneous conception. As a consequence, in the majority of these patients the only opportunity of childbearing is eggs donation or adoption. Certainly, early diagnosis is crucial to counsel POI patients about their future prospective of childbearing and possibly address them to oocytes cryopreservation. The only possibility for patients to conceive with their own gametes, is when the diagnosis is made during the “transitional phase”, when amenorrhea and menopausal symptoms have not yet arisen. Although, some researchers have shown the persistence of meiosis and primordial follicles replenishment even during postnatal life in animal models, other researchers reported less optimistic results. Future research should focus on this topic and on the possibility to stop, or at least to slow down, ovarian ageing.